新诊断2型糖尿病患者两种短期胰岛素强化治疗的比较

Two regimes of transient intensive insulin therapy in newly diagnosed type 2 diabetic patients

目的比较两种短期胰岛素强化治疗对新诊断的2型糖尿病患者血糖控制和胰岛β细胞功能的影响。方法新诊断的空腹血糖（FPG）≥10．0mmol／L、糖化血红蛋白（HbAlc）≥8．0％的2型糖尿病患者68例，行持续皮下注射胰岛素（持续皮下组，36例）或每日多次皮下注射胰岛素（多次皮下组，32例）治疗，强化控制血糖达标后，比较两组胰岛素日用量，治疗前后体重指数、稳态模型计算的胰岛素分泌功能指数（HOMA-β）、胰岛素抵抗指数（HOMA-IR）和胰岛素曲线下面积。结果两组血糖控制达标时间差异无统计学意义；治疗前后体重指数差异无统计学意义；最大胰岛素日用量持续皮下组（0．53±0．06）U·kg^-1·d^-1，多次皮下组（0．71±0．04）U·kg^-1·d^-1（t=11．100，P〈0．01）；两组治疗前后HOMA—β及胰岛素曲线下面积差异有统计学意义（P〈0．01），组间比较差异无统计学意义；两组治疗前后及组间HOMA-IR比较差异均无统计学意义。两组均无严重低血糖发生，中等程度低血糖发生率持续皮下组为0．34％（13／3806人次），皮下多次组为1．09％（44／4045人次）。结论新诊断的2型糖尿病患者，皮下多次与持续注射胰岛素治疗可以短期内有效控制血糖，显著改善胰岛β细胞功能而不增加胰岛素抵抗。持续注射给药所用胰岛素量小、中等程度低血糖发生率低。

Objective To evaluate two regimes of transient intensive insulin therapy in newly diagnosed type 2 diabetic patients with severe hyperglycemia. Methods Sixty-eight newly diagnosed type 2 diabetic patients with fasting plasma glucose （FPG） ≥ 10.0 mmol/L and glycated hemoglobin Alc （HbAlc） ≥ 8.0% were randomized to either continuous subcutaneous insulin infusion （CSII）group or multiple daily injection（MDI） group. Glycemic control, daily dose of insulin, body mass index （BMI）, the mean area under the insulin curve（ AUC）, β-cell function （HOMA-β） and insulin resistence （HOMA-IR） were compared before and after treatment. Results There were no significant differences between two groups in days reaching giycemic control and BMI. The maximal insulin dose for glycemic control in CSII group was （0.53 ±0.06） U · kg^-1 · d^-1 and that in MDI group was （0.71 ±0.04） U · kg^-1 · d^-1（t = 11.100, P 〈 0.01）. After CSII and MDI treatment, HOMA-β and the mean AUC of insulin were significantly increased （ P 〈 0. 01 ）, but there was no significant difference between two groups （P 〉 0. 05 ）. No significant changes in HOMA-IR were observed before and after treatment or between two groups. There were no severe hypoglycemic episodes in two groups and mild hypoglycemic episodes were 0.34% （ 13/ 3806） in CSII group and 1.09% （44/4045） in MDI group. Conclusions The excellent glycemic control can be reached by short-term CSII and MDI treatment in newly diagnosed type 2 diabetic patients with severe hyperglycemia. Lower insulin dose and less mild hypoglycemic episodes seem to be the advantage of CSII regime than MDI regime, β-cell function can be dramatically improved in both therapy regimes.